C-REACTIVE PROTEIN AND HAPTOGLOBIN IN THE EVALUATION OF A COMMUNITY-BASED MALARIA CONTROL PROGRAM

When cross-sectional surveys are used to evaluate malaria intervention programmes in the community, the prevalence of morbidity is difficult to assess because of the fluctuating nature of malarial fever. We hav e therefore investigated the impact of bed net usage on 2 surrogate ma rkers of malarial morbidity: ii) elevated C-reactive protein (CRP) (>8 mg/L) plus detectable parasitaemia, as an indicator of malaria-induce d acute-phase response; and (ii) reduced haptoglobin levels (<180 mg/L ), which in this population indicates malaria-induced intravascular ha emolysis. Among 1505 Gambian children 1-5 years old, examined on a sin gle occasion at the end of the malarial transmission season, 5% had pa rasitaemia plus fever, while 24%. had parasitaemia plus elevated CRP, and 35% had low haptoglobin. The proportion of children who had parasi taemia plus elevated CRP was significantly lower among those who had s lept under insecticide-treated bed nets than among those who did not u se a bed net (16% vs. 34%, P<0.003), and the proportion with low hapto globin differed similarly (24% vs. 49%, P<0.003). Use of an untreated bed net had a weaker effect on both indices (22% had parasitaemia plus elevated CRP, 34% had low haptoglobin). CRP and haptoglobin are simpl e and inexpensive to measure in large numbers of people, and these res ults suggest that they could be useful for the assessment of malaria i ntervention programmes.